‘Traditional pain medicines can sometimes do more harm than good’

Pain specialist and Honorary Clinical Director of Integro Medical Clinics, Dr Anthony Ordman tells Sarah Sinclair why cannabis based medicines should be taken seriously as an alternative to conventional medicines – and how we can bring them into the mainstream.

“On balance, the medicines which we traditionally use to treat long-term pain, can do more harm than good,” says Dr Anthony Ordman, a senior pain specialist with more than 25 years experience in treating patients with long-term pain.

“If we’re not careful, we’re in danger of people being made worse by their pain medicines rather than better, for example they may end up over-sedated, but without any reduction in pain.”

Earlier this year, The National Institute of Health and Care Excellence (NICE) published a report on the use of medications for the treatment of long-term pain. It referred to a ‘lack of evidence’ for the long-term effectiveness of many of these medicines, and a risk of long-term harm, advising doctors not to prescribe common painkillers such as paracetamol and ibuprofen for patients with chronic pain.

Dr Anthony Ordman agrees that many conventional medicines have little to offer those living with conditions such as fibromyalgia.

“Doctors may prescribe these medicines in a well-meaning way, but only about a quarter of patients are really helped by them, whereas they all tend to experience side effects including sedation and memory deficit.

They can also tend to get hooked on them and never come off,” he adds.

“We have to find other options.”

As Honorary Clinical Director at Integro, Dr Ordman does offer patients alternative options. These take the form of cannabis based medicines, which he believes can often be more effective for treating chronic health conditions.

“We’ve been aware of the body’s natural endocannabinoid system for a long time. We believe this can become unbalanced in pain states and can often be re-balanced using cannabis based substances,” he explains.

“Medical science has known about this system for 30 years, but because of drug regulations and a concern among most doctors about the reputation of cannabis medicines, little progress was made.”

But in 2018, the regulations were changed so that medical specialists could prescribe cannabis based medicines. As far as Dr Ordman is concerned cannabis medicines can be a useful part of a whole-person approach to medicine, something which has always been at the heart of his medical practice.

Patient-centered care was a philosophy which he brought this with him to Integro, where patients are looked after by a team of clinical professionals, including a specialist nurse, in order to offer the best treatment possible.

“If patients have already tried cannabis based medicines, we listen carefully to their experience, and try to build on that,” he says.

“We try to work in partnership, rather than a paternalistic way, and there’s always somebody for patients to phone if they have a query or a problem. This is the sort of medicine I have always been keen to practice.”

Rather than just attempting to control pain, as is often the case with opioids, cannabis based medicines can be used to tackle a number of elements associated with pain which might also be affecting the patient’s quality of life, for example anxiety, poor sleep and low mood.

“Adverse life experiences, especially in childhood, can make peoples’ bodies much more prone to chronic pain later on, and what we’re often trying to do is restore balance in body systems which have become unbalanced by these experiences, or by ill-health, injury, and so on,” says Dr Ordman.

“I believe that, for example in fibromyalgia, real neurological changes have happened as a result of intense stress.”

He continues: “A lot of patients with long term pain or anxiety have impaired sleep physiology, so they wake up exhausted, and their body hasn’t had a chance to heal during the night. Cannabis medicines can help restore healthier physiological sleep patterns, which pain medicine now realises can be really important for restoring physical health and reducing pain.

“Another benefit of cannabis medicines is that they may be able to reduce inflammation in various parts of the body, and many types of pain are driven by inflammation, for example at the sites of injury and arthritis.”

One example is that some patients treated for Crohn’s Disease, an inflammatory condition of the digestive system, who are prescribed cannabis medicines to help manage their pain, may notice a reduction in the frequency of their flare ups as well.

Although Integro Clinics keep their charges to a minimum and have reliable access, via their partner pharmacy to high quality cannabis medicines currently it is mainly those able to afford to purchase their cannabis medicines who are able to access these treatments.

While Dr Ordman acknowledges that some forward-thinking consultants are taking an interest in using medical cannabis, helping more clinicians to understand cannabis medicines is key to seeing wider access through the NHS, he feels.

“The way forward in bringing cannabis based medicines more into mainstream medicine is through the understanding from a doctor’s point of view, that the chemicals in cannabis should just be regarded as molecules, like any other medicine.”

“Just as morphine came originally from poppies, and the heart medicine digoxin came from foxgloves we’re dealing here with chemicals which just happen to come from a cannabis plant. And like morphine or digoxin, these also work on systems that have been present in animals for millions of years.”

He adds: “Patients may tend to view cannabis medicines in a romantic way, because they’re from a cannabis plant, but doctors are more likely to see them in a more matter of fact way, as chemical extracts from cannabis which we can measure and analyse, in proper controlled ways.”

But patients do have an important part to play, as they are often the most knowledgeable and best-placed to broach the subject of medical cannabis with their doctors. Often they will have tried medical cannabis for their long-term condition and have a good idea of what best suits their condition.

“I think the way into the NHS and broader acceptance may be through expert patient groups and providing scientific and other information that patients can take to their appointments. This could inform their consultants or GP’s and put them in touch with their cannabis medicine doctor in a way that doesn’t seem to be confrontational.”

Dr Ordman is currently inviting a few select NHS colleagues to join him at Integro Clinics, where they would be supported in learning about prescribing cannabis-based medicines for a range of conditions and to carry out much-needed clinical trials.

“We’d love to have a gastroenterologist, a rheumatologist, a psychiatrist, as well as an adult and pediatric neurologist as colleagues at Integro Clinics”, he adds.

“Making lead consultants in the NHS aware of how cannabis medicines can be valuable for patients with hard-to-treat conditions such as intractable pain or epilepsy is important, and there may be other conditions for which cannabis medicines have more to offer, perhaps in conjunction with conventional medicines.”

Find out more and get in touch with Dr Ordman’s team at www.integroclinics.com <http://www.integroclinics.com/>

Integro Clinics Ltd always recommend remaining under the care and treatment of your GP and specialist for your condition while using cannabis based medicines, and the Integro clinical team would always prefer to work in collaboration with them.